Accident and emergency psychiatry

Up to 5% of patients attending accident and emergency (A&E) departments present with primary psychiatric problems, whilst another 20–30% have psychiatric symptoms in addition to physical disorders. This article discusses the commonest psychiatric presentations to A&E, including self-harm, acute psychosis, and alcohol and substance misuse. It also describes common clinical problems in A&E, including frequent attenders, patients who do not wait to be seen, violence and aggression, and psychological responses to trauma. Issues of service delivery and safety are also discussed. The key to a successful A&E psychiatric service is a good working relationship between A&E and mental health staff.